Provider Demographics
NPI:1528038924
Name:BARTLETT, THERESA HUTCHINSON (AUD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:HUTCHINSON
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 PRINCESS ANNE RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7962
Mailing Address - Country:US
Mailing Address - Phone:757-461-4327
Mailing Address - Fax:757-226-8022
Practice Address - Street 1:4540 PRINCESS ANNE RD
Practice Address - Street 2:SUITE 123
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7962
Practice Address - Country:US
Practice Address - Phone:757-461-4327
Practice Address - Fax:757-226-8022
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000546231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010197295Medicaid
VA010197295Medicaid